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Case Study of IPE SIM Development
Case Study of IPE SIM Development
JB is a registered nurse and is the Clinical Practice Educator for her Emergency Department. Her team has recently experienced a trauma resuscitation that had a poor outcome. The review of this case suggested that team dynamics was an area of opportunity for improvement for the team, and JB has been tasked with developing a multidisciplinary education initiative to foster team work and improve team dynamics. JB has decided to develop a simulation event to engage all the disciplines of her team in the care of an acutely injured patient. Following is the process JB followed in the formulation of her SIM.
Define Your Audience
Define Your Audience
Since the highlighted event was a trauma resuscitation JB starts her SIM planning by making a list of the key players that are involved in a typical resuscitation event at her facility, and she reviews the members of the team that were present during the initial case to ensure representation is included for all disciplines involved. This includes a spectrum of disciplines from the Trauma Surgeon and Emergency Room Physician, to the bedside RN and LPN team, and is inclusive of other members who support the unit at these times including Porters, Unit Clerk, Transfusion Services and Diagnostic Imaging teams.
Establish Learning Goals
Establish Learning Goals
The primary goal of this IPE SIM event is to reinforce crisis resource management principles in high stress situations, in particular communication, distribution of workload, and clarity in roles and responsibilities.
The scenario JB develops is not designed to stump the team or lead them into a HALO (high acuity, low occurrence) treatment pathway, rather it will present decisions points that require interdisciplinary knowledge and collaborative skill sets to address.
As van Dieggele et al., (2021) suggest, JB chooses the core competency themes of communication, collaboration/teamwork, and role responsibilities as desired outcomes from this IPE offering.
With these core competencies in mind JB collaborates with members of the other disciplines that are to participate in the SIM to assess applicability of the scenario to the respective lenses of the other disciplines. The goal is to support the alignment of applicable learning goals for all attendees regardless of discipline.
Know Your Environment
Know Your Environment
It is imperative that JB becomes familiar with the simulation equipment, the level of fidelity it offers, and understand how to support learners' interactions with the simulation mannequins. Since SIM is not her primary role JB enlists the support of her local SIM team to support her use and selection of appropriate equipment for her teams' learning.
JB also invest time prior to the SIM becoming familiar with the role of facilitator as educator, and with the physical set up of her chosen learning environment. To enhance fidelity JB opts for insitu learning where the IPE SIM will take place in the resuscitation bay of the Emergency Room. This will support suspension of disbelief in the participants and enhance the realism of interactions among the space and the team.
Having a pre-prepared pre-brief script is key to your success as a facilitator. Above is an example script I (Brad) use for the spectrum of scenarios from low fidelity to high fidelity.
Set the Stage
Set the Stage
Prepare Everyone for Experiential Learning
JB follows the following steps in preparing for her SIM event:
Establish a 'fiction contract' with participants in which learners are asked to suspend disbelief. This asks themselves to buy into the SIM scenario as if it were real life so that the best learning can occur.
Clearly state learning objectives, both the learners' and instructors', orientate learners to the environment and equipment, and outline the properties of the SIM including the timing for the debriefing (Rudolph, et al., 2014).
Clarify participants roles (function within own disciplines' scope).
Establish the safe container for learning where all participants mutually agree that performance is evaluated on a systems and process lens, and that individual practice will not be discussed outside of the SIM environment.
Encourage questions and feedback to support transparency in the entire process. Be welcoming and invitational to the exciting potential learning that is about to occur.
IPE SIM Time
IPE SIM Time
Let the team learn safely, collaboratively, together
A debrief script is also invaluable to guide your conversation and engagement of the learners in reflective learning.
Eloquent, genuine, supportive advocacy is an artform that takes time and practice to become proficient with.
The Debrief
The Debrief
Foster Transformative Learning Through Reflection
"The role of the facilitator or debriefer is to create an emotionally safe environment for the learners to explore their thought processes, review their clinical decisions, comprehend their strengths and weaknesses, and reinvent new strategies for developing better interprofessional skills within the context of the multidisciplinary team" (Gasteratos, et al., 2024, p453-454).
JB completes a literature search on SIM debriefing and selects an advocacy-inquiry approach as conversational strategy to explore what learners were thinking during the simulation. This is an approach from a perspective of genuine curiosity and desire to understand the others' thoughts and perspectives, in efforts to facilitate a reflective learner centric discussion. JB will be supported in the role of educator and facilitator for this event by selected practice educators/experts from the other disciplines who will support feedback and debriefing that align with the frames of their respective disciplines. The goal is to foster team learning with, about and from one another.
Advocacy: clearly stating your observations and perspective about that observation, understanding that you may not be correct in this assessment.
Inquiry: is an open-ended invitation for the receiver to share their perspective on the topic of observation (Buttimer, 2018)
Important to note that feedback differs from debriefing. "Feedback is defined as information about performance which is provided to the learners with the intent to modify thinking or behavior to facilitate learning and improve future performance... In contrast, debriefing is an interactive, bidirectional, and reflective discussion" (Jamalpuri, et al., 2016, p54)
PEARLS Healthcare Debriefing Tool
PEARLS Healthcare Debriefing Tool
Sharing this open source tool to support your debriefing learning, and to be available to guide future IPE SIM facilitation/teaching.
Self-Reflection
Consider your current health care discipline and working environment. Has your team used SIM before? Is there a role for IPE SIM in your team? Can you think of a scenario or care situation in which the care delivery by your team could have been practiced in a simulated learning environment?
Image References:
Image retrieved from: https://simzine.news/wp-content/uploads/2023/11/ERC-Congress-1.jpg
Image retrieved from: https://d8it4huxumps7.cloudfront.net/uploads/images/6577cf1c623e0_simulation_training_cycle.jpg?d=2000x2000
Image retrieved from: https://i.ytimg.com/vi/fp0wRF7QuRY/hq720.jpg?sqp=-oaymwEhCK4FEIIDSFryq4qpAxMIARUAAAAAGAElAADIQj0AgKJD&rs=AOn4CLCVxEL9-aFXjCq1eLowoC2VSlBaPQ
Images retrieved from: Bajaj, K., Meguerdichian, M., Thoma, B., Huang, S., Eppich, W., & Cheng, A. (2018). The PEARLS healthcare debriefing tool. Academic Medicine, 93(2), p336.
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